Healthcare Provider Details

I. General information

NPI: 1013723048
Provider Name (Legal Business Name): BEDROCK PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 N PIERCE ST STE 212
LITTLE ROCK AR
72207-5357
US

IV. Provider business mailing address

PO BOX 241248
LITTLE ROCK AR
72223-0005
US

V. Phone/Fax

Practice location:
  • Phone: 501-725-0205
  • Fax: 254-212-4442
Mailing address:
  • Phone: 501-725-0205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KELSEY MCCLELLAN
Title or Position: OWNER
Credential: MD
Phone: 501-725-0205